Osteoporotic ankle fractures result from mechanical forces that would not ordinarily result in fracture, known as 'low-energy' trauma, such as those equivalent to a fall from a standing height or less. Osteoporotic ankle fractures in frail patients are becoming more and more frequent in daily practice and represent a therapeutic challenge for orthopaedic surgeons. The main problems with frail patients are the poor condition of the soft tissues around the ankle, dependence for activities of daily living and high comorbidity. The decision to operate on these patients is complex because conservative treatment is poorly tolerated in unstable fractures and conventional open reduction and internal fixation is associated with a high rate of complications. The authors conducted a narrative review of the literature on primary tibiotalocalcaneal nailing of ankle fractures in frail patients and categorized the different factors to consider when treatment is indicated for this conditon. Difficulty of ambulation, age over 65 years old, deteriorated baseline state and instability of the fracture were the most frequently considered factors. Finally, the authors propose an easy and quick clinical scoring system to help in the decision-making process, although further comparative studies are required to explore its validity.

中文翻译：

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用于体弱患者骨质疏松性踝关节骨折的胫跟骨钉：叙述性回顾与决策过程的临床评分建议。

骨质疏松性踝关节骨折是由通常不会导致骨折的机械力引起的，称为“低能量”创伤，例如相当于从站立高度或更低的高度跌落。体弱患者的骨质疏松性踝关节骨折在日常实践中变得越来越频繁，这对整形外科医生来说是一个治疗挑战。体弱患者的主要问题是踝关节周围软组织状况不佳、对日常生活活动的依赖和高合并症。对这些患者进行手术的决定是复杂的，因为在不稳定骨折中保守治疗的耐受性很差，并且传统的切开复位和内固定与高并发症发生率相关。作者对虚弱患者踝关节骨折原发性胫跟骨钉的文献进行了叙述性回顾，并对针对这种情况进行治疗时需要考虑的不同因素进行了分类。行走困难、年龄超过 65 岁、基线状态恶化和骨折不稳定是最常考虑的因素。最后，作者提出了一个简单快捷的临床评分系统，以帮助决策过程，尽管需要进一步的比较研究来探索其有效性。基线状态恶化和骨折不稳定性是最常考虑的因素。最后，作者提出了一个简单快捷的临床评分系统，以帮助决策过程，尽管需要进一步的比较研究来探索其有效性。基线状态恶化和骨折不稳定性是最常考虑的因素。最后，作者提出了一个简单快捷的临床评分系统，以帮助决策过程，尽管需要进一步的比较研究来探索其有效性。